Provider Demographics
NPI:1881622561
Name:DOZIER, DOUGLAS P SR (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:P
Last Name:DOZIER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5038
Mailing Address - Country:US
Mailing Address - Phone:478-477-9412
Mailing Address - Fax:800-618-8689
Practice Address - Street 1:4000 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5038
Practice Address - Country:US
Practice Address - Phone:478-477-9412
Practice Address - Fax:800-618-8689
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015372207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000093431AMedicaid
GA000093431AMedicaid
409113837Medicare PIN
D29332Medicare UPIN